While the use of nitrous oxide for pain control during labor is common in Europe, its use fell out of favor in the U.S. with the introduction of epidural anesthesia, the most common pain relief method. There are some who believe it’s time for nitrous oxide to make a comeback in U.S. delivery rooms, but others say “not so fast.”
The merits of nitrous oxide will be debated from 8:10 to 9 am Saturday in Ballroom D during this year’s Morton and Diane Stenchever Lecture, “Nitrous Oxide in Labor: The Good, The Bad, and The Ugly.”
Laura Goetzl, MD, MPH, professor of obstetrics, gynecology, and reproductive sciences and director of the Division of Maternal-Fetal Medicine at Temple University, Lewis Katz School of Medicine in Philadelphia, will argue in favor of more widespread use of nitrous oxide. Supporting the “not so fast” position will be Mark Zakowsky, MD, clinical director and chief of obstetric anesthesiology at Cedars-Sinai Medical Center in Los Angeles.
“I think some women have wanted alternatives to epidural, and nitrous oxide is a great option that has been gaining in popularity in this country,” Dr. Goetzl said. “There were a handful of vanguard centers in the U.S. that reintroduced nitrous oxide and have started to publish some data on their experiences with it, but there are decades of experience and safety data in Europe, so if it was really that dangerous we should have seen some reports to that effect by now.”
Dr. Goetzl believes that nitrous oxide is a particularly good option for women who, for any number of reasons, cannot or do not want to have an epidural.
“Nitrous oxide is a win-win option,” Dr. Goetzl said. “It’s a win for American women who want to have more options for pain control in labor, and it’s a win for hospitals that offer it because it gives them an additional therapy to offer women who are in pain. Nitrous oxide doesn’t cost as much as other pain medications, has better pain outcomes, and clears out of mom’s system quickly, as needed.”
Dr. Zakowski agrees that more options for women are good, but believes that there are several reasons why the use of nitrous oxide warrants a more cautious approach.
“Proponents of nitrous oxide promote it for pain relief during labor; however, the analgesic benefits of nitrous oxide are, I think, overstated,” he said. “When you look at the scientific studies, it doesn’t really reduce the pain, as determined by scientific measurements, such as visual analog scores. It’s more of a dissociative anesthetic so, in that regard, it’s almost a misnomer to promote it as a pain reliever.”
Among the specific concerns related to the use of nitrous oxide, Dr. Zakowski said, are the metabolic and genetic effects of prolonged exposure on the mother and the baby, as well as long-term effects on medical staff attending deliveries where nitrous oxide is commonly used.
“Although it’s been used widely for years in other countries, we’re learning that nitrous oxide has a dark underside and may not be as safe as it seems,” Dr. Zakowski said. “And, while it was not specific to nitrous oxide, the FDA put out a statement in 2016 warning against the use of general anesthesia for pregnant women in their third trimester so, for now anyway, the use of nitrous oxide in labor and delivery is an elective choice that I would advise against.”